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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006512
Report Date: 08/13/2024
Date Signed: 08/13/2024 01:49:18 PM

Document Has Been Signed on 08/13/2024 01:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MAXWELL H. & MURIEL GLUCK CCC, LLC, THEFACILITY NUMBER:
372006512
ADMINISTRATOR/
DIRECTOR:		KRISTY FORDFACILITY TYPE:
830
ADDRESS:10660 JOHN J HOPKINS DRIVETELEPHONE:
(858) 455-5220
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 30DATE:
08/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Kirsty FordTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 8/13/24 at 1:15 PM, Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced case management inspection. The purpose of this visit was to follow up on a self reported unusual incident report dated 7/23/24. Director, Kirsty Ford provided a tour of the facility. LPA observed the 4 infant rooms and are within ratio & capacity.

The infant classroom was toured to ensure that facility is following safe sleep regulations. Facility has reported that infant (I1) was not placed on their back for nap time for about 20 minutes. Safe sleep regulation states that all infant 0-12 months must be placed on their backs.
LPA also inquired about the nap supervision and verified sleep log documentation.

See 809D for Deficiency Cited

Exit interview conducted and report was reviewed with the Director, Kirsty Ford. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/13/2024 01:49 PM - It Cannot Be Edited


Created By: Annette Sutherland On 08/13/2024 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MAXWELL H. & MURIEL GLUCK CCC, LLC, THE
FACILITY NUMBER: 372006512

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2024
Section Cited
CCR
101430(a)(3)(A)

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101430 Infant Care Activities (a)(3)(A) Staff shall place infants up to 12 month of age on their backs for sleeping. This requirement is not met as evidenced by:
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Correction has already been addressed. Facility has retrained staff and proof was provided to department.
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Based on self reported incident. (I#1) Infant was not placed on their back which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joelle Redding
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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